晏怡 唐文渊 重庆医科大学附一院神经外科 400016 中国神经精神疾病杂志 2000 0 26 5


    关键词：亚低温；诱发电位；脑外伤；格拉斯哥昏迷评分；治疗 期刊 zgsjjsjbzz 0 279-282 论著与学术交流 fur -->/info/meeting/meeting02.asp?keyword=神经病学


    

【摘要】 目的 探讨亚低温对急性重型脑外伤的疗效。方法 选择受伤后10小时内入院的急性重型脑外伤患者(GCS≤8)44例，按伤情轻重分为GCS6～8分和GCS 3～5分两组，各组再随机分成亚低温组和对照组。亚低温组(32～34℃)于降温前、降温后4、24、48、72、96、120小时及复温后监测正中神经短潜伏期体感诱发电位(SLSEP)的N₂₀ 波幅和脑干听觉诱发电位(BAEP)的I、V波幅比值；对照组在同样的时段监测上述指标，并行统计学分析比较。结果 GCS6～8分的亚低温组降温24小时及其后的两个诱发电位(EP)指标较对照组有显著性差异，前者存活比例(10/14)亦高于后者(3/10)。GCS3～5分组有无亚低温治疗者，其EP检测结果及存活比例两组间均无显著性差异。结论 从EP监测显示：亚低温对于重型脑外伤中GCS6～8分者有显著的治疗作用，对3～5分的病例则无明显疗效。

Neuroelectrophysiologicalstudy of mild hypothermia in the treatment of severe head injury

Yan Yi Tang Wenyuan

    (Department of Neurosurgery, The First Hospital ofChongqing University of Medical Sciences, 1, Youyi Road, Chongqing. 400016. Tel:023-69012239 )

【Abstract 】Objective To investigate theeffects of hypothermia on acute severe brain injury.Methods From May 1998 to March 1999, patients admitted with severe closedhead injuries (Glasgow Coma Scale scores 3 to 8, within 10 hours after injury) wereselected for this study. According to the severity of injury, 44 patients were classifiedinto two groups: GCS 3-5 and GCS 6-8. Patients of each group were then randomly assignedto treatment with normothermia or hypothermia. In hypothermia group, patients were cooledto 32-34 ℃ and N₂₀ amplitudes in mediannerve short-latency somatosensory evoked potentials (SLSEP) and I/V amplitudes in brainstem auditory evoked potentials (BAEP) were measured before cooling, at 4 hours, 24 hours,48 hours, 96 hours, 120 hours after cooling and after warming. The same parameters weremeassured at the same time in the normothermia group. The changes of evoked potentialshave been analysed by statistical methods.Results InGCS 6-8 group, N₂₀ amplitudes in SLSEP and I/V amplitudes in BAEP aftertreatment of mild hypothermia were found significantly different between hypothermia andnormothermia subgroup, while no significant difference of all parameters between twosubgroups in GCS 3-5 group. Conclusions Theseresults demonstrate that treatment with mild hypothermia in patients with GCS of 6-8 isbeneficial in terms of improved neuroelectrophysiology. However, mild hypothermia inpatients with GCS of 3-5 may not be so effective.

     【Key words 】 Mild hypothermia Evokedpotentials Head injury GCS Treatment

急性重型脑外伤后的脑缺血缺氧是外伤后继发性脑损害的主要原因^[1] ......